MEDICARE: CRAIN AND CARMAN INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy	5551	MO
2	332B00000X	Durable Medical Equipment & Medical Supplies		MO
3	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2616526	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1700991742
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRAIN AND CARMAN INC

Provider Business Mailing Address
First Line	:	864 N KINGSHIGHWAY ST
Second Line	:
City	:	CAPE GIRARDEAU
State	:	MO
Zip	:	63701-4316
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	864 N KINGSHIGHWAY ST
Second Line	:
City	:	CAPE GIRARDEAU
State	:	MO
Zip	:	63701-4316
Country	:	US
Telephone Number	:	573-334-4761
Fax Number	:	573-334-6695

Authorized Official
Title or Position	:	THIRD PARTY PLAN COORDINATOR
Name	:	DENA FERMAN
Credential	:
Telephone Number	:	314-993-6000

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	08/23/2007

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Directions to “CRAIN AND CARMAN INC ” Practice Location

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